Patients should receive nuanced counseling that caters to their unique ovarian response, according to a recent study in JAMA Network Open.
Takeaways
- Patients' unique ovarian responses require individualized counseling, especially for those undergoing planned oocyte cryopreservation (OC).
- Because of delayed childbirth and technological advancements, there's a rising trend in planned OC. However, the effectiveness and follow-up data regarding its outcomes remain limited.
- Traditional research on poor ovarian response (POR) has been limited to infertile patients. Many individuals undergoing planned OC might not respond optimally to ovarian stimulation, complicating their counseling and treatment pathways.
- Patients with POR were more likely to return to use their cryopreserved oocytes than those with normal responses. The time taken to return varied between these groups, with those having a POR taking slightly less time.
- The age groups of 30 to 34 years and 35 to 39 years were most common for planned OC. Within these groups, there was a notable trend of increased OC utilization among those identified as poor responders.
A shift toward delaying childbirth and advancements in technology have led to increased rates of oocyte cryopreservation (OC) among reproductive-aged individuals. This is referred to as planned OC, and there is a lack of follow-up data to determine its efficacy.
Most research on poor ovarian response (POR) has focused on patients with infertility, but there are many patients who may not experience a response to ovarian stimulation matching their prospective family planning. This makes it difficult for clinicians to counsel patients with POR who underwent a planned OC.
While increasing the number of planned OC cycles may improve live birth rates, it may be time-consuming and costly in fertile patients. Therefore, withdrawal from OC treatment may be recommended.
Investigators conducted a study to determine the association between ovarian response during stimulation and the odds of patients choosing planned OC. Data was collected from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), containing over 85% of fertility clinical annual reporting in the United States.
Participants included individuals receiving planned OC for nonmedical, non-infertility-related reasons. Patients with other indications for cryopreservation were excluded from the analysis. Data about age, race and ethnicity, body mass index, geographic location, specific indication for egg freezing, and presence of a partner at OC was collected.
Race and ethnicity were determined based on data reported by clinics to SART. SART data was also used to link OC cycles to their respective thaw cycles.
Investigators defined the primary outcome of the analysis as, “the return rate to utilize cryopreserved oocytes following planned OC, as well as the time to return, in relation to the number of oocytes vitrified.”The cryopreservation warm interval was determined by measuring the time between OC and subsequent warming, defined as the time to return.
There were 47,363 patients with planned OC cycles included in the final analysis, 13.5% of whom had less than 5 oocytes across all cycles and were described as POR. Among the POR group, the mean number of total verified oocytes was 2.8, vs 14.1 in the normal responders group.
A total 1203 patients in the overall cohort returned for oocyte warming. A 4% rate of return was reported in the POR group and 2.3% in the normal responders group.
Overall, patients who returned to utilize their eggs had a higher rate of POR. These patients also had an increased prevalence of POR diagnosis at ovarian stimulation. Among patients aged 30 to 34 years and 35 to 39 years, the 2 most common age groups for planned OC, this trend was particularly common.
Having under 5 oocytes cryopreserved was also associated with increased odds of using oocytes. Among the POR group, the average time to return was 716.1 days, vs 803.8 days in the normal responders group.
These results indicated an increased risk of OC utilization among poor responders. Investigators concluded nuanced counseling should be utilized to manage each patient’s unique ovarian response.
Reference
Fouks Y, Sakkas D, Bortoletto PE, Penzias AS, Seidler EA, Vaughan DA. Utilization of cryopreserved oocytes in patients with poor ovarian response after planned oocyte cryopreservation. JAMA Netw Open. 2024;7(1):e2349722. doi:10.1001/jamanetworkopen.2023.49722
